Prevention strategies in clinical high-risks states for psychotic disorders: weighing up costs and benefits

Abstract Today, the indicated prevention of psychosis prior to its first episode is mainly based on clinical high-risk of psychosis (CHR) criteria, namely ultra-high risk criteria and basic symptom criteria. These are associated with conversion-to-psychosis rates of about 30% within three years. Thus, many patients meeting CHR criteria will not progress to psychosis over a medium-term period, and the cost-benefit evaluation of CHR states is always complicated by the largely unknown individual psychosis risk of CHR patients. In consequence, for the lesser risk of adverse events, treatment recommendations commonly favour non-pharmacological strategies, in particular cognitive-behavioural psychotherapy. Yet, individual risk estimation in identified CHR patients is increasingly done with help of machine learning algorithms, which might help to identify CHR patients who would greatly benefit from an additional pharmacological intervention with low-dose antipsychotics. The presentation will discuss the evidence-base of such a multistep, machine learning informed prevention strategy. Disclosure of Interest None Declared

Abstract: Early detection and intervention are critical for improved outcomes in mental disorders, and this is particularly true for bipolar disorders. Understanding the risk factors involved in the onset of the disease and the subsequent relapses and recurrences may lead to better results as regards to functional outcomes, which are the most relevant for patients and their significant others. This presentation will review those factors and discuss which ones can be used as targets for early intervention. It has been argued that, most often, early intervention comes late, and it is therefore paramount to build on strategies aimed at effective detection of people at risk and situations that may lead to recurring episodes of illness. Treatments not only aimed at treating symptoms, but at improving illness trajectories are necessary, and pharmacological formulations and interventions improving treatment adherence are particularly relevant to avoid interruptions of effective therapies.

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Cognitive functions and their correlates in people with psychosis: are there gender differences? Abstract: Impairments in social and non-social cognition are common in psychosis and may be sparsely present even before the onset of the disorder. Genetic and environmental influences have been linked to cognitive dysfunctions, which, in turn, may significantly impact the real-world functioning of people with psychosis. The role of gender in determining the interplay between cognitive skills, risk factors, and outcomes has been relatively unexplored. Nevertheless, identifying putative gender differences in cognitive functions and their correlates may favor the identification of individualized prevention and treatment strategies.

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High number of refugees in Italy -which strategy works in Italy?

S. Galderisi
University of Campania "Luigi Vanvitelli", Naples, Italy doi: 10.1192/j.eurpsy.2023.117 Abstract: A negative impact on mental health of Ukrainian people who will survive the war is very likely. Those who leave are exposed to the trauma of leaving behind home, relatives, friends, job, habits, i.e., most of what they had built in their life, and to the unpleasant feeling of knowing nothing of what they will go through. Mutual support and nurture problem-solving strategies, including favoring family reunion, restoring people dignity and control over the environment, help children recover a more positive social reality, are major protective factors in buffering the impact of war, displacement and related trauma. By November 2022, Italy had hosted more than 170.000 Ukrainian refugees. The National Service intervention, coordinated by the Civil Protection Department, has developed a Plan for the reception and assistance of the population from Ukraine to uniform the response to the emergency on the national territory. The plan has focused on two aspects: humanitarian assistance and reception. The network for reception is composed of the CAS -Extraordinary Reception Centers and the SAI -Integration Reception System. The Plan also provides measures related to health care and education to ensure mandatory vaccination requirements and the access to the school system for unaccompanied foreign minors. As to plans aimed to address mental health issues, the right to care is guaranteed, but several issues can be identified that limit the impact of the national policies on the needs of this population.

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Prevention strategies in clinical high-risks states for psychotic disorders: weighing up costs and benefits Abstract: Today, the indicated prevention of psychosis prior to its first episode is mainly based on clinical high-risk of psychosis (CHR) criteria, namely ultra-high risk criteria and basic symptom criteria. These are associated with conversion-to-psychosis rates of about 30% within three years. Thus, many patients meeting CHR criteria will not progress to psychosis over a medium-term period, and the cost-benefit evaluation of CHR states is always complicated by the largely unknown individual psychosis risk of CHR patients. In consequence, for the lesser risk of adverse events, treatment recommendations commonly favour non-pharmacological strategies, in particular cognitive-behavioural psychotherapy. Yet, individual risk estimation in identified CHR patients is increasingly done with help of machine learning algorithms, which might help to identify CHR patients who would greatly benefit from an additional pharmacological intervention with low-dose antipsychotics. The presentation will discuss the evidence-base of such a multistep, machine learning informed prevention strategy. Abstract: Over the past decades the role of sex in the antipsychotic treatment type and dose selection has been virtually overseen. In fact, medication approval trials barely stratify for sex differences. Emerging hints from different types of data highlight the need for antipsychotic treatment personalization within the context of sex differences. Varying bioavaibility patterns of the prescribed antipsychotics between female and male patients may be easy to capture measuring plasma or serum levels of the antipsychotics ultimately guiding dose selection in clinical routine. Here we will discuss pitfalls and current evidence regarding sex affecting dose selection to enhance safety and effectiveness outcomes of antipsychotic treatment.

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Overwhelming number of refugees in Poland -which strategy is being pursued Abstract: By the decision of the Polish Government, all persons arriving in the territory of the Republic of Poland after the commencement of the Russian aggression against Ukraine have free access to public psychiatric assistance, including reimbursement of pharmacological treatment on the same terms as Polish citizens. According to the UHNR data over 4 million displaced people, refugees, came to Poland so far and some of them benefited from such help. Displaced individuals suffer from the consequences of traumatic events, exhibit psychological problems or develop mental disorders, including post-traumatic stress disorder, depressive and anxiety disorders or relapses of psychotic episodes. The lecture will present data from the Interdisciplinary War in Ukraine Research Laboratory by pointing out the most important problems faced by Ukrainian refugees in Poland, why they chose Poland when escaping the war, how they evaluate Polish help, what their integration in Poland looks like. The survey also measured the level of war trauma (RHS-15). The results of the analysis show that most refugees present post-traumatic stress disorder symptoms (76 %), while only 0.15% of this population was treated in public psychiatric facilities. Mental healthcare services are suddenly faced with major challenges and need to develop or expand strategies to address them. The Polish Ministry of Health prepared and started implementation of a reform of the mental health care system for adult as well as children and adolescent psychiatry. This fundamental reform should comprise three main actions, i.e. integration of mental health services into primary healthcare; establishment of community psychiatric services together with the provision of inpatient services in general hospitals; and limitation of the role of mental hospitals to specific tasks only (long-term or specialist treatment).

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Pharmacological treatment of early psychosis: risks and benefits L. Sīle 1,2 1 Research and education department, Rigas Centre of Psychiatry and Addiction medicine and 2 Psychiatry and Addiction medicine, Rigas Stardins University, Riga, Latvia doi: 10.1192/j.eurpsy.2023 Abstract: Psychiatry has changed a lot during the last decades and lot of effort has been made to ensure that treatment of schizophrenia spectrum disorders is in line with modern science of medicine. Therefore, in everyday practice the psychiatrist is in a constant process of decision making when to start pharmacological treatment of early psychosis and with what dosage. The lecture will include evidence-based treatment options, the aspects of clinical practice and the power of shared decision-making in psychiatry.